Altered right ventricular papillary muscle position and orientation in patients with a dilated left ventricle

Spinner, Erin M.; Sundareswaran, Kartik S.; Dasi, Lakshimi Prasad; Thourani, Vinod H.; Oshinski, John N.; Yoganathan, Ajit P.

doi:10.1016/j.jtcvs.2010.05.034

Cited by 17 publications

(9 citation statements)

References 13 publications

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“…13,32 A recent study conducted by our group found that dilatation of the LV can affect RV PM position, with displacement of the septal PM toward the center of the RV in patients with a dilated LV. 27 Although the previous study was unable to specifically correlate the presence of TR in these patients with the PM displacement, the results presented in this study may give us an idea of how the lateral displacement reported in patients may cause TR.…”

Section: Discussionmentioning

confidence: 62%

“…PMs were positioned with the APM farthest from the annulus plane and the SPM closest, as reported for normal subjects with the use of magnetic resonance imaging. 27 This was achieved with 3-dimensional adjustable rods with the use of a system of gears, as used in previous studies 17,28 ( Figure 3). The PMs were then adjusted apically to ensure that the chordae were neither taut nor slack.…”

Section: Papillary Muscle Positioningmentioning

confidence: 99%

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In Vitro Characterization of the Mechanisms Responsible for Functional Tricuspid Regurgitation

et al. 2011

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Background-Functional tricuspid regurgitation (TR) is increasingly recognized as a source of morbidity. Current repair strategies focus on annular remodeling because annular dilatation is common in patients with TR. Although papillary muscle (PM) displacement is recognized in functional mitral regurgitation, its role in TR is less well characterized. The objective of this in vitro study was to further clarify the mechanisms by which TR occurs as an effect of annular dilatation and PM displacement. Methods and Results-Porcine tricuspid valves (nϭ16) were studied in an in vitro right heart simulator. The valve dynamics were quantified with isolated annular dilatation starting with a normal annular size (6 cm 2 ) and incrementally dilated up to 100%, isolated PM displacement, and a combination of the 2. All valves lost competence at 40% dilatation, resulting in a TR of 7.9Ϯ3.4 mL (PՅ0.05) compared with baseline and central residual leaflet length of 0.5Ϯ0.2 cm. Multidirectional displacement of the anterior and posterior/septal PMs and all PMs significantly (PՅ0.05) increased TR, with normal annular area. Malcoaptation was observed where the 3 leaflets joined with all significant levels of TR. The anterior leaflet had the greatest percent change in residual leaflet length, whereas PM displacement caused a reduction in residual leaflet length for the septal leaflet for all conditions. Conclusions-This study shows that although annular dilatation alone leads to TR, isolated PM displacement can also cause TR; annular remodeling strategies should be tailored in the setting of severe PM displacement. (Circulation. 2011;124:920-929.)

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Section: Discussionmentioning

confidence: 62%

Section: Papillary Muscle Positioningmentioning

confidence: 99%

In Vitro Characterization of the Mechanisms Responsible for Functional Tricuspid Regurgitation

et al. 2011

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“…It is believed that right ventricle (RV) dilatation may result in displacement of the anterior PM (APM), 12,13 while another study reported displacement of the septal PM (SPM) toward the center of the RV with left ventricle (LV) dilatation. 14 However, these prior studies were unable to directly correlate these finding to the magnitude of TR.…”

Section: Clinical Perspective On P 50mentioning

confidence: 93%

Correlates of Tricuspid Regurgitation as Determined by 3D Echocardiography: Pulmonary Arterial Pressure, Ventricle Geometry, Annular Dilatation, and Papillary Muscle Displacement

Spinner

Lerakis

Higginson

et al. 2012

Circ: Cardiovascular Imaging

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Background-While it is understood that annular dilatation contributes to tricuspid regurgitation (TR), other factors are less clear. The geometry of the right ventricle (RV) and left ventricle (LV) may alter tricuspid annulus size and papillary muscle (PM) positions leading to TR. Methods and Results-Three-dimensional echocardiographic images were obtained at Emory University Hospital using a GE Vivid 7 ultrasound system. End-diastolic area was used to classify ventricle geometry: control (nϭ21), isolated RV dilatation (nϭ17), isolated LV dilatation (nϭ13), and both RV and LV dilatation (nϭ13).

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“…37,38 Also supporting this concept is that prophylactic tricuspid annuloplasty performs well in the long term because it specifically targets tricuspid annular dilation. 19,39 Severe TR is accompanied by RV expansion, and this dilation is often irreversible, as are annular changes. 38,40 RV function is an independent factor for mortality among patients with TR, 41 and TR treatment often does not improve mortality among patients with RV dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Pathogenic structural heart changes in early tricuspid regurgitation

Nemoto

Lesser

Pedersen

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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Altered right ventricular papillary muscle position and orientation in patients with a dilated left ventricle

Cited by 17 publications

References 13 publications

In Vitro Characterization of the Mechanisms Responsible for Functional Tricuspid Regurgitation

In Vitro Characterization of the Mechanisms Responsible for Functional Tricuspid Regurgitation

Correlates of Tricuspid Regurgitation as Determined by 3D Echocardiography: Pulmonary Arterial Pressure, Ventricle Geometry, Annular Dilatation, and Papillary Muscle Displacement

Pathogenic structural heart changes in early tricuspid regurgitation

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